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Acute Inpatient Stroke Care Module Update

The revised Acute Inpatient Stroke Care recommendations are published in the International Journal of Stroke this week and are part of the fifth edition of the Heart and Stroke Foundation Canadian Stroke Best Practice Recommendations.

Click here to download the recommendations from the International Journal of Stroke website.

The 2015 update of the Canadian Stroke Best Practice Recommendations (CSBPR) Acute Inpatient Stroke Care recommendations continue to emphasize the significant impact that organized stroke units with interprofessional stroke teams have on patient outcomes following stroke. Acute stroke care refers to the key interventions involved in the assessment, treatment, management, and early recovery in the first days after stroke onset, and these recommendations refer to inpatient hospital settings. New updates are included around early mobilization and preventing complications including venous thromboembolism.

Specific highlights of the updates and additions include:

  • Focus on the core elements and components of stroke unit care, and advocacy that the elements should be implemented as fully as possible within resource capability.
  • Edits to the section on reducing complications – specifically venous thromboembolism prophylaxis based on the results of the CLOTS 3 trial and early mobilization based on the most recent release of the AVERT trial.
  • Expanded guidance on addressing palliative care issues in patients with severe stroke.
  • Emphasis within recommendations on initiating advance-care planning discussions with patients and family members.
  • Further development of a Taking Action Towards Optimal Inpatient Stroke Care resource kit including creating a stroke unit with staffing models, stroke care information, educational modules, summary tables of implementation tools, outcome measures, and resource links.
  • Updated patient order set templates for initial ED evaluation, tPA administration, acute inpatient admission, and management of intracerebral hemorrhage.

The theme for the 2014 – 2015 updates is Working Together with Stroke Survivors and their Caregivers to Achieve Optimal Outcomes, emphasizing the need for a committed interprofessional team approach to stroke care across the continuum, and for ensuring patient-centred care. Patients and family caregivers particularly should receive education and be empowered as active participants throughout their journey of recovery to ensure meaningful contributions to goal setting and treatment planning.

Supporting information including rationale, system implications, performance measures and implementation resources are available online at the Heart and Stroke Foundation at www.strokebestpractices.ca.

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